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  • 1.
    Blixt, Ingrid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Johansson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Papoutsi, Zoi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Department of Health Science Faculty of Medicine, Lund University, Lund, Sweden.
    Women's advice to healthcare professionals regarding breastfeeding: "offer sensitive individualized breastfeeding support"- an interview study2019In: International Breastfeeding Journal, ISSN 1746-4358, E-ISSN 1746-4358, Vol. 14, article id 51Article in journal (Refereed)
    Abstract [en]

    Background

    The World Health Organization recommends exclusive breastfeeding for 6 months followed by continued breastfeeding with complementary food up to 2 years of age or beyond. Few women achieve this recommendation in Sweden, and they often stop breastfeeding earlier than they would like. Investigating women's advice to healthcare professionals is important for the provision of optimal breastfeeding support. The aim of this study was to explore women's advice to healthcare professionals regarding support for continuing to breastfeed for at least 6 months.

    Methods

    This investigation used an exploratory study design, and a purposive sample of women was recruited between 2015 and 2016 through social media platforms. The work is a follow-up of an earlier study exploring women's perceptions of the factors that assisted them in breastfeeding for at least 6 months. Telephone interviews were conducted with 139 Swedish women who reported that they had breastfed for at least 6 months. Women were asked the question, "Do you have any advice that you would like to give to healthcare professionals regarding breastfeeding support?". The data were analysed using content analysis.

    Results

    The theme, "Professionals need to offer women sensitive, individualized breastfeeding support to promote a positive breastfeeding experience", describes the women's advice based on five categories: 1) providing evidence-based care, 2) preparing expectant parents during pregnancy, 3) creating a respectful and mutual dialogue, 4) offering individual solutions to breastfeeding problems, and 5) offering practical support.

    Conclusions

    This study highlights the importance of professionals providing evidence-based breastfeeding support in a sensitive and individualized manner. This consideration is an important prerequisite to strengthening women's self-confidence and assisting them in reaching their breastfeeding goals, which may enhance the positive nature of their breastfeeding experience.

  • 2. Fenwick, Jennifer
    et al.
    Bayes, Sara
    Johansson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    A qualitative investigation into the pregnancy experiences and childbirth expectations of Australian fathers-to-be.2012In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, no 1, p. 3-9Article in journal (Refereed)
    Abstract [en]

    AIM: To explore and describe men's experiences of pregnancy and childbirth expectations.

    BACKGROUND: There remains limited work exploring expectant father's perspectives.

    DESIGN: Qualitative descriptive design. Twelve Australian expectant fathers participated in between 1 and 2 interviews during pregnancy and 1 after childbirth (32 in total). Six fathers also chose to submit a number of diary entries via e-mail. Thematic analysis was used to analyse the data set.

    FINDINGS: Five themes emerged from the data. The themes pregnancy news: heralds profound change adjusting to pregnancy, and birth looming described how men processed the news of pregnancy, worked to accept their changed circumstances and negotiated the final week of the pregnancy. A fourth theme, labelled Feeling sidelined, outlined men's experiences of antenatal care and their feeling of isolation as a result of largely feeling ignored by health care professionals. The fifth theme represents men's childbirth expectations.

    CONCLUSION: Adjusting to the news of a pregnancy was a potentially unsettling time for an expectant father that was often associated with increased apprehension and anxiety. Regardless of whether they were a first or once again father most men engaged in a level of emotional work to come to terms with and accept the pregnancy. Understanding men's antenatal experiences and anxieties is an important step in the development of preventative paternal perinatal mental health measures. The significance of this work is situated within the reality that men's wellbeing is associated with maternal psychological well-being, positive peri-natal experiences and child development.

  • 3.
    Hildingsson, Ingegerd
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Haines, Helen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Johansson, Margareta
    Södersjukhuset, Stockholm, Sweden.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Fenwick, Jennifer
    School of Nursing and Midwifery, Maternity and Family, Centre for Health Practice Innovation (HPI), Griffith Health Institute, Griffith University, Australia.
    Childbirth fear in Swedish fathers is associated with parental stress as well as poor physical and mental health2014In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 2, p. 248-254Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    to compare self-rated health and perceived difficulties during pregnancy as well as antenatal attendance, birth experience and parental stress in fathers with and without childbirth related fear.

    DESIGN:

    a longitudinal regional survey. Data were collected by three questionnaires.

    SETTING:

    three hospitals in the middle-north part of Sweden.

    PARTICIPANTS:

    1047 expectant fathers recruited in mid-pregnancy and followed up at two months and one year after birth.

    MEASUREMENTS:

    childbirth fear was assessed using the Fear of Birth Scale (FOBS). Self-rated physical and mental health and perceived difficulties were assessed in mid pregnancy. Two months after birth antenatal attendance, mode of birth and the birth experience were investigated. Parental stress was measured using the Swedish Parental Stress Questionnaire (SPSQ). Crude and adjusted odds ratios were calculated between expectant fathers who scored 50 and above (childbirth fear) and those that did not (no fear).

    FINDINGS:

    expectant fathers with childbirth related fear (13.6%) reported poorer physical (OR 1.8; 95% CI 1.2-2.8) and mental (OR 3.0; 1.8-5.1) health than their non-fearful counterparts. The fearful fathers were more likely to perceive difficulties in pregnancy (OR 2.1; 1.4-3.0), and the forthcoming birth (OR 4.3; 2.9-6.3) compared to fathers without childbirth fear. First-time fathers with fear attended fewer antenatal classes. Fathers with high fear reported higher mean scores in four of the five subscales of the SPSQ. Childbirth related fear was not associated with mode of birth or fathers' birth experience.

    KEY CONCLUSIONS:

    expectant fathers with childbirth related fear had poorer health, viewed the pregnancy, birth and the forthcoming parenthood with more difficulties. They were less often present during antenatal classes and had higher parental stress.

    IMPLICATIONS FOR PRACTICE:

    this study provides insight into the health of expectant fathers during pregnancy and highlights the importance of understanding how childbirth fear may affect expectant fathers in both the short and longer term.

  • 4.
    Hildingsson, Ingegerd
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Johansson, Margareta
    Mid Sweden University, Department of Health Science, Sundsvall, Sweden.
    Fenwick, Jennifer
    Griffith University, Gold Coast Hospital, Australia.
    Haines, Helen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Childbirth fear in expectant fathers: Findings from a regional Swedish cohort study2014In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 2, p. 242-247Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    to investigate the prevalence of childbirth related fear in Swedish fathers and associated factors.

    DESIGN:

    a regional cohort study. Data was collected by a questionnaire.

    SETTING:

    three hospitals in the middle-north part of Sweden

    PARTICIPANTS:

    1047 expectant fathers recruited in mid-pregnancy during one year (2007) who completed the Fear of Birth Scale (FOBS).

    MEASUREMENTS:

    prevalence of childbirth fear and associated factors. Crude and adjusted odds ratios were calculated between men who scored 50 and above (childbirth fear) and those that did not (no fear). Logistic regression analysis was used to assess which factors contributed most to childbirth fear in fathers.

    FINDINGS:

    the prevalence of childbirth fear in men was 13.6%. Factors associated with childbirth related fear were as follows: Less positive feelings about the approaching birth (OR 3.4; 2.2-5.2), country of birth other than Sweden (OR 2.8; 1.3-6.1), a preference for a caesarean birth (OR 2.1; 1.7-4.1), childbirth thoughts in mid-pregnancy (OR 1.9; 1.1-2.0) and expecting the first baby (OR 1.8; 1.2-2.6).

    KEY CONCLUSIONS:

    high levels of fear were associated with first time fathers and being a non-native to Sweden. Men with fear were more likely to experience pregnancy and the coming birth as a negative event. These men were also more likely to identify caesarean section as their preferred mode of birth.

    IMPLICATIONS FOR PRACTICE:

    engaging expectant fathers in antenatal conversations about their experiences of pregnancy and feelings about birth provides health-care professionals with an opportunity to address childbirth fear, share relevant information and promote birth as a normal but significant life event.

  • 5.
    Hildingsson, Ingegerd
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Johansson, Margareta
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Karlström, Annika
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Fenwick, Jennifer
    Griffith Health Institute, School of Nursing and Midwifery, Griffith University, Logan Brisbane, Australia and Gold Coast Hospital.
    Factors Associated With a Positive Birth Experience: An Exploration of Swedish Women’s Experiences2013In: International Journal of Childbirth, ISSN 2156-5287, E-ISSN 2156-5295, Vol. 3, no 3, p. 153-164Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The birth of a baby is a powerful life event that has implications for a woman's wellbeing and future health. A positive birth experience promotes a sense of achievement, enhances feeling of self-worth, and facilitates confidence—all of which are important for a healthy adaptation to motherhood and psychological growth. Understanding what constitutes a positive birth experience is critical to providing maternity care that meets childbearing women's individual needs, preferences, and priorities.

    OBJECTIVE:

    To explore the prevalence of Swedish women reporting a very positive birth experience 2 months and 1 year after childbirth and identify factors associated with this experience. In addition, the study aimed to identify whether women's assessment of their birth experience changed over time.

    METHOD:

    A prospective, longitudinal study where the main outcome variable was perceptions of a very positive birth experience. The study was undertaken in a Northern region of Sweden in 2007. Women were recruited at their ultrasound examination in midpregnancy. Data was collected via questionnaires. There were 928 women who responded to questions about their birth experience at 2 months postpartum. Nearly 83% of these women (n = 763) also completed the questionnaire package 1 year after birth. Descriptive statistics were used together with Friedman's test to detect changes over time. Logistic regression analysis was performed to reveal which factors contributed most to a very positive birth experience.

    RESULT:

    More than a third of the women reported a very positive birth experience. Women's assessment of birth changed over time with 22% of the women becoming more positive and 15% more negative. Important associated factors for a very positive birth experience included positive feelings about the approaching birth as well as feeling in control, using no or only cognitive forms of pain management, and achieving a spontaneous vaginal birth. Furthermore, how women rated their midwifery care was also shown to affect their assessment of their birth experience.

    CONCLUSION:

    This study found that women's birth experiences changed over time and most becoming more positive after 1 year. Factors associated with a very positive birth experience were related to women's prenatal attitudes, intrapartum procedures, pain relief used, and care received during labor and birth. Respectful individualized midwifery care that remains focused on the woman and keeping birth normal increases positive perceptions of the birth experience.

  • 6.
    Hildingsson, Ingegerd
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Karlström, Annika
    Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Haines, Helen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Univ Melbourne, Rural Hlth Acad Ctr, Melbourne Med Sch, Northeast Hlth Wangaratta Educ & Res Unit, Melbourne, Vic, Australia. Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden..
    Johansson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Swedish women's interest in models of midwifery care - Time to consider the system?: A prospective longitudinal survey2016In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 7, p. 27-32Article in journal (Refereed)
    Abstract [en]

    Background: Sweden has an international reputation for offering high quality maternity care, although models that provide continuity of care are rare. The aim was to explore women's interest in models of care such as continuity with the same midwife, homebirth and birth center care. Methods: A prospective longitudinal survey where 758 women's interest in models such as having the same midwife throughout antenatal, intrapartum and postpartum care, homebirth with a known midwife, and birth center care were investigated. Results: Approximately 50% wanted continuity of care with the same midwife throughout pregnancy, birth and the postpartum period. Few participants were interested in birth center care or home birth. Fear of giving birth was associated with a preference for continuity with midwife. Conclusions: Continuity with the same midwife could be of certain importance to women with childbirth fear. Models that offer continuity of care with one or two midwives are safe, cost-effective and enhance the chance of having a normal birth, a positive birth experience and possibly reduce fear of birth. The evidence is now overwhelming that all women should have maternity care delivered in this way.

  • 7.
    Johansson, M.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Radestad, I.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Karlstrom, A.
    Hildingsson, Ingegerd
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Few fathers-to-be prefer caesarean section for the birth of their baby2010In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 117, no 6, p. 761-764Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to investigate prospective fathers' preferences for caesarean section and associated factors. Data were collected by means of a questionnaire given in mid-pregnancy to 1105 fathers-to-be in northern Sweden. In total, 6.4% of fathers preferred a caesarean section. The factors associated with a preference for caesarean section were a wish to plan the date of the baby's birth [prevalence ratio (PR) 6.0], a previous negative birth experience (PR 8.6) and previous experience of a caesarean section (PR 5.7).

  • 8. Johansson, Margareta
    et al.
    Edwardsson, Cecilia
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    The “Pregnant Man” - Expecting Fathers Experience Pregnancy-Related Changes: A Longitudinal Study With a Mixed Method Approach2015In: Journal of Men's Health, ISSN 1875-6867, E-ISSN 1875-6859, Vol. 11, no 6, p. 6-18Article in journal (Refereed)
  • 9.
    Johansson, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Fenwick, J
    Premberg, A
    A meta-synthesis of fathers' experiences of their partner's labour and the birth of their baby.2015In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, no 1, p. 9-18, article id S0266-6138(14)00127-2Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to develop greater understanding of how expectant fathers experience their partner's labour and the subsequent birth of their baby.

    DESIGN: a qualitative meta-synthesis. Data were search for in CINAHL, PubMed, Psych Info and SCOPUS.

    SETTING: eight studies conducted in England, Malawi, Nepal and Sweden were included.

    PARTICIPANTS: 120 fathers with experiences of their partner having a spontaneous vaginal, assisted or surgical birth.

    MEASUREMENTS AND FINDINGS: 1st order themes were identified and subsequently grouped into seven 2nd order themes. Finally through a process of exploring patterns and connections seven 3rd order themes were developed which produced new insights into the men's experiences of labour and birth. This meta-synthesis revealed that most men wanted to be actively involved in their partner's labour, present at the birth and respected for what they could contribute. Men recognised that birth was a unique event that may be potentially challenging requiring a level of preparation. There were also men who felt pressured to attend. During the actual experience of labour men commonly expressed overwhelming feelings and inadequacy in their ability to support their partner. They particularly struggled with the 'pain' of labour. Midwives were subsequently identified as best placed to make a significant difference to how men perceived their experiences of labour and what they described as the life changing event of birth.

    KEY CONCLUSIONS: the expectant fathers' birth experiences were multidimensional. Many were committed to being involved during labour and birth but often felt vulnerable. Being prepared and receiving support were essential elements of positive experience as well as contributing to their ability to adequately support the labouring woman.

    IMPLICATIONS FOR PRACTICE: men's ability to actively prepare for, and be supported through, the labour and birth process influences their perceptions of the childbirth event as well as their sense of connection to their partner. Couples should be given opportunities to explore expectations and how these may influence their own construction of their role during the birth process. While the role of expectant fathers in labour and birth should be facilitated and supported arguably their wish not to participate should be afforded the same respect.

  • 10.
    Johansson, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Fenwick, Jennifer
    School of Nursing and Midwifery, Griffith University Logan Campus and MENZIE Health, Queensland, Australia.
    Thies-Lagergren, Li
    Department of Midwifery Research - Reproductive, Perinatal and Sexual health, Lund University, Lund, Sweden..
    Mothers' experiences of pain during breastfeeding in the early postnatal period: A short report in a Swedish context.2019In: American Journal of Human Biology, ISSN 1042-0533, E-ISSN 1520-6300, article id e23363Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The objective was to investigate the prevalence of mothers who experienced pain during breastfeeding in the early postnatal period and to describe associated factors.

    METHODS: Medical records of 987 mothers and their babies were scrutinized. Chi-square Test, McNemar's test, and relative risk with a 95% confidence interval were applied for analysis.

    RESULTS: During the in-hospital postnatal stay, 19.5% mothers experienced pain during breastfeeding. At discharge, the rate was 8.8% (ρ < .001) and at the follow-up hospital visit 2 to 3 days after birth 17.5% (ρ = .104). Pain when breastfeeding was associated with primiparity (RR 2.02; 95% CI 1.53-2.66), epidural block during labor (RR 1.50; 95% CI 1.17-1.94), cracked nipples (RR 5.94; 95% CI 4.84-7.27), the use of a nipple shield (RR 6.34; 95% CI 5.43-7.41), supplementary feeding (RR 2.19; 95% CI 1.71-2.80), and longer hospital stay (RR 1.88; 95% CI 1.46-2.42).

    CONCLUSIONS: During the early postnatal period, Swedish mothers commonly experienced pain during breastfeeding. Although the rate dropped at discharge, it rose again by the time mothers returned for their follow-up visit. The rebound rate could be explained by breast engorgement, a baby's shallow latch or the effect of an epidural block. Midwives and nurses assisting women during intrapartum and postpartum care must be aware of factors associated with pain during early breastfeeding.

  • 11.
    Johansson, Margareta
    et al.
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Intrapartum care could be improved according to Swedish fathers: Mode of birth matters for satisfaction2013In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 26, no 3, p. 195-201Article in journal (Refereed)
    Abstract [en]

    Background: Intrapartum care is expected to be shaped by parents' need and preferences. Aim: The aim was to explore Swedish fathers' intrapartum care quality experiences, with a specific focus on care deficiencies in relation to birth mode. A secondary aim was to explore which issues of quality that contributed most to dissatisfaction with the overall assessment of the care. Methods: Cross-sectional design, part of a prospective longitudinal survey in Sweden. A quality of care index was developed, based on perceived reality and subjective importance of given intrapartum care. Two months after birth 827 fathers answered nine questions related to quality of care. Descriptive statistics and logistic regression analysis were used. Results: Dissatisfaction with overall intrapartum care was related to deficiencies in partner's medical care (OR 5.6; 2.7-11.2), involvement in decision-making during childbirth (OR 2.6; 1.3-4.9), midwives presence in the labour room (OR 2.4; 1.2-4.7), and ability to discuss the birth afterwards (OR 2.0; 1.1-3.8). After emergency caesarean section 46% judged the partner's medical intrapartum care as most deficient (OR 1.73; 1.05-2.86), and after elective caesarean section 40% of the fathers judged involvement in decision-making as deficient (OR 4.07; 1.95-8.50). When the fathers had participated in a spontaneous vaginal birth they were dissatisfied with the presence of the midwife in the labour room (OR 1.72; 1.03-2.87). Conclusions: Deficiencies existed in the intrapartum care and were judged differently depending on mode of birth. The fathers needed to feel secure about the women's medical care, and wanted to be involved and supported.

  • 12.
    Johansson, Margareta
    et al.
    Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Fenwick, Jennifer
    School of Nursing and Midwifery, Maternity and Family Unit, Research Centre for Clinical and Community Practice Innovation (RCCCPI), Griffith Health Institute, Griffith University, Meadowbrook, Queensland, Australia f Gold Coast Hospital, Australia.
    'As long as they are safe - Birth mode does not matter' Swedish fathers' experiences of decision-making around caesarean section2014In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 27, no 3, p. 208-213Article in journal (Refereed)
    Abstract [en]

    Background: Decision-making in childbirth involves considerations about both the mother and her unborn baby's wellbeing. For men the safety of both is paramount. Aim: To explore and describe Swedish fathers' beliefs and attitudes around the decision for a caesarean section. Methods: Qualitative descriptive study. Twenty one Swedish men whose partners had experienced elective or emergency caesarean participated in a telephone interview. Thematic data analysis was used. Findings: The theme, 'Childbirth is Risky', included "Caesarean birth has lots of advantages" and "Birth mode does not matter". In the context of having experienced a caesarean section male partners considered birth mode to be irrelevant. The majority considered caesarean to be a quick and efficient way of giving birth which equated to being safer. Most men could articulate some risks associated with caesarean but these were mainly minimised. The second theme, 'Simply a matter of trust: Birth mode is not my decision', reflected men's belief that they had little to contribute to the decisions made around birth mode. The decision for a caesarean section was considered to lie with the medical practitioner. Conclusion: Mode of birth was regarded as unimportant. The recommendation for a caesarean section was readily accepted and appreciated, and shifted responsibility for birth to the medical practitioner. Involving men in the decision-making process by means of giving them information was valued. Men's limited knowledge about the risks of a caesarean may contribute to birth mode decisions. Professionals need to provide balanced and correct information within the context of individual circumstances. (C) 2014 Australian College of Midwives.

  • 13.
    Johansson, Margareta
    et al.
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Fenwick, Jennifer
    School of Nursing and Midwifery, Griffith University, Australia.
    Fathers want to stay close to their partner and new baby in the early postnatal period: The importance of being able to room in after a surgical birth2013In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, no 1, p. 35-36Article in journal (Refereed)
    Abstract [en]

    The early postnatal period can be challenging for new fathers especially when their partner has experienced a caesarean section. The aim of this study was to describe men's perceptions and feelings of staying with their partner and new baby in the context of having experienced a surgical birth. Thematic analysis was employed" to analyse telephone interviews collected from 21 Swedish fathers who had experienced elective or emergency caesarean section. Being involved, receiving support and providing support were main reasons men considered it important they be facilitated to stay with their partners. Postnatal care should be oriented towards the whole family.

  • 14. Johansson, Margareta
    et al.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Fenwick, Jennifer
    Important factors working to mediate Swedish fathers' experiences of a caesarean section2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 9, p. 1041-1049Article in journal (Refereed)
    Abstract [en]

    Objective: to describe and explore fathers' experiences of their partner's caesarean section birth. Design: a qualitative descriptive design was employed. A self-selected sample of 22 Swedish fathers who had experienced an elective or emergency caesarean section agreed to participate. Men were interviewed by telephone seven to 16 months after the birth of their baby. Thematic analysis and the techniques of constant comparison were used to analyse the data. Findings: men were generally worried about the health and well-being of their baby and partner regardless of birth mode. As the reality of the caesarean section approached men's anxiety escalated and remained high during the procedure. The rapid nature of surgical birth was therefore considered as an advantage; once the baby was born and cried men's fear dissipated. Four factors were identified that mediated the men's experience. Men's perceptions of control, preparedness and how the health-care team behaved and interacted with them were integral to their experience. Knowing the date and time of birth also mediated the experience by providing a sense of certainty to men's experiences of the caesarean birth. Key conclusions: caesarean section was considered as a routine and safe procedure that offered most fathers a sense of certainty, control and safety lessening their sense of responsibility over ensuring a healthy baby. The communication patterns of staff played a key role in ensuring a positive caesarean birth experience. Implications for practice: ensuring that men have a positive birth experience, regardless of birth mode, is important for family functioning. However the findings also lend insight into how men may reframe caesarean birth as normal and safe. This may have implications for decision making around birth mode in a subsequent pregnancy further impacting on rising repeat caesarean section rates. Health-care professionals need to provide balanced information about the risks associated with caesarean birth. Any potential benefits need to be contextualised to the pregnant woman's own individual situation. Where possible, and appropriate, professional discourses should support vaginal birth as the safest option for a woman and her baby.

  • 15.
    Johansson, Margareta
    et al.
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Rådestad, Ingela
    Department of Caring Sciences, Sophiahemmet University College, Stockholm, Sweden.
    Hildingsson, Ingegerd
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Childbirth - an emotionally demanding experience for fathers.2012In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, no 1, p. 11-20Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: While attending birth mostly has a positive impact on becoming a father, it has also been described as including feelings of discomfort and is more demanding than expected.

    OBJECTIVE: The objective was to explore Swedish fathers' birth experiences, and factors associated with a less-positive birth experience.

    METHODS: Mixed methods including quantitative and qualitative data were used. Two months after birth 827 fathers answered a questionnaire and 111 (13%) of these commented on the birth experience. Data were analysed with descriptive statistics, chi-square test for independence, risk ratios with a 95% confidence interval, logistic regression and content analysis.

    RESULTS: In total, 604 (74%) of the fathers had a positive or very positive birth experience. Used method identified a less-positive birth experience associated with emergency caesarean section (RR 7.5; 4.1-13.6), instrumental vaginal birth (RR 4.2; 2.3-8.0), and dissatisfaction with the partner's medical care (RR 4.6; 2.7-7.8). Healthcare professionals' competence and approach to the fathers were also related to the birth experience.

    CONCLUSIONS: As the fathers' birth experiences were associated with mode of birth and experiences of the intrapartum medical care fathers should be respectfully and empathically treated during labour and birth. It is essential to better engage fathers during the intrapartum period through involvement and support to improve the likelihood of a positive birth experience.

  • 16. Johansson, Margareta
    et al.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Rådestad, Ingela
    Hildingsson, Ingegerd
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Improvements of postnatal care are required by Swedish fathers2013In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 26, no 5, p. 465-480Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    This paper has two main aims: to explore fathers' postnatal care experiences with a specific focus on deficiencies and to investigate which service deficiencies remained important for fathers one year after childbirth.

    DESIGN/METHODOLOGY/APPROACH:

    This is a prospective longitudinal study. Two months and one year after birth, the overall satisfaction with care were sought. A care quality index was created, based on perceived reality and subjective importance of the care given. The study excluded fathers not mastering Swedish. Total eligible fathers was consequently not known therefore pregnancies served as an estimate.

    FINDINGS:

    In total, 827 fathers answered the questionnaire two months after birth and 655 returned the follow-up questionnaire after one year; 21 per cent were dissatisfied with overall postnatal-care. The most important dissatisfying factors were the way fathers were treated by staff and the women's check-up/medical care. Two months after the birth, information given about the baby's care and needs were most deficient when parents had been cared for in a hotel ward. Furthermore, information about the baby's needs and woman's check-up/medical care was most deficient when fathers had participated in emergency Caesarean section.

    PRACTICAL IMPLICATIONS:

    Most fathers were satisfied with the overall postnatal care, but how fathers are treated by caregivers; the woman's check-up/medical care and information given about the baby's care and needs can be improved. Professionals should view early parenthood as a joint project and support both parents' needs.

    ORIGINALITY/VALUE:

    The paper provides knowledge about postnatal service quality including fathers' needs.

  • 17. Johansson, Margareta
    et al.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Rådestad, Ingela
    Hildingsson, Ingegerd
    The Internet: one important source for pregnancy and childbirth information among prospective fathers2010In: Journal of Men's Health, ISSN 1875-6867, Vol. 7, no 3, p. 249-258Article in journal (Refereed)
    Abstract [en]

    Background Fathers involvement in pregnancy and childbirth has increased and this can benefit their own health as well as their partners' and children's health The objective of this study was to investigate the sources of pregnancy and childbirth information that expectant fathers used in pregnancy with a specific focus on the Internet Methods This was a cross-sectional study of 1105 prospective fathers in Sweden Data were collected in a single year by means of a questionnaire in mid-pregnancy Results The Internet was used by 58% of the fathers The Internet as a source of information was more often used by fathers expecting their first child (relative risk (RR) = 1 4 range = 1 2-1 7), fathers with a high level of education (RR = 1 3 range = 1 2-1 5) and those who had a previous experience of caesarean section (RR = 1 3 range = 1 1-1 6) Other important sources for pregnancy and childbirth information were the midwife and the pregnant partner Conclusions The Internet is in addition to the midwife and the pregnant partner, a common source of pregnancy and childbirth information for prospective fathers Antenatal caregivers need to be updated about preferable web sites for pregnancy and childbirth information and give the couple a chance to reflect and talk about what they retrieve from the Internet.

  • 18.
    Johansson, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Thies-Lagergren, Li
    Swedish fathers' experiences of childbirth in relation to maternal birth position: a mixed method study.2015In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 28, no 4, p. e140-7, article id S1871-5192(15)00056-6Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Fathers often want to be involved in labour and birth.

    AIM: To investigate how maternal birth position during second stage of labour may influence fathers' experience of childbirth.

    METHODS: Mixed method study with 221 Swedish fathers completing an on-line questionnaire. Descriptive statistics and qualitative content analysis were used.

    RESULTS: In total 174 (78.7%) had a positive overall birth experience. The theme An emotional life-changing event influenced by the birth process and the structure of obstetrical care was revealed and included the categories; Midwives ability to be professional, The birth process' impact, and Being prepared to participate. The most frequently utilised birth position during a spontaneous vaginal birth was birth seat (n=83; 45.1%), and the fathers in this group were more likely to assess the birth position as very positive (n=40; 54.8%) compared to other upright and horizontal birth positions. Fathers with a partner having an upright birth position were more likely to have had a positive birth experience (p=0.048), to have felt comfortable (p=0.003) and powerful (p=0.019) compared to women adopting a horizontal birth position during a spontaneous vaginal birth. When the women had an upright birth position the fathers deemed the second stage of labour to have been more rapid (mean VAS 7.01 vs. 4.53) compared to women in a horizontal birth position.

    CONCLUSION: An upright birth position enhances fathers' experience of having been positively and actively engaged in the birth process. Midwives can enhance fathers' feelings of involvement and participation by attentiveness through interaction and communicating skills.

  • 19.
    Johansson, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Soder Sjukhuset, Dept Obstet & Gynecol, Stockholm, Sweden.
    Thies-Lagergren, Li
    Lund Univ, Dept Midwifery Res Reprod Perinatal & Sexual Hlth, Lund, Sweden;Helsingborg Lasarett, Dept Obstet & Gynecol, Helsingborg, Sweden.
    Wells, Michael B.
    Karolinska Inst, Dept Publ Hlth Sci, Solna, Sweden.
    Mothers' experiences in relation to a new Swedish postnatal home-based model of midwifery care: A cross-sectional study2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 78, p. 140-149Article in journal (Refereed)
    Abstract [en]

    Background: The goal of postnatal care is to provide the highest possible quality of care and medical safety with the least possible intervention in order to optimize health and wellbeing of the new family. The aim of the study was to describe mothers ' experiences in relation to a new postnatal home-based model of midwifery care.

    Methods: The current study uses a cross-sectional mixed method design to assess a new postnatal home-based model of midwifery care in Sweden. Healthy women with an uncomplicated pregnancy and child-birth, and with a healthy baby answered an online questionnaire one week after birth. Data were collected during one year (2017-2018) and analyzed using descriptive and inferential statistics for quantitative data, and manifest content analysis for qualitative data.

    Findings: In total, 180 mothers with one to six children were included. They were most likely to have been discharged between six and 12 h after childbirth (56%) and 90% reported that the time for their discharge was good. The postnatal check-ups included were telephone contact (100%), home visit(s) (94%) and hospital visit(s) (98%). Most mothers had a positive postnatal care experience from using the new postnatal model of midwifery care (mean VAS 8.74, Std. Deviation 1.438). For 75%, of the participants, home-based postnatal care would be preferred for their next childbirth.

    Conclusion: Home-based postnatal care is well accepted by mothers who were discharged early after childbirth. Mothers with a positive experience of the new postnatal model of midwifery care would prefer home-based postnatal care for their next childbirth. Midwifery care should include home-based postnatal care.

  • 20.
    Johansson, Margareta
    et al.
    Karolinska Inst, Dept Clin Sci & Educ, Sjukhusbacken 10, SE-11883 Stockholm, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, SE-11883 Stockholm, Sweden..
    Thomas, Jan
    Kenyon Coll, Dept Sociol, Gambier, OH 43022 USA..
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Karolinska Inst, Dept Womens & Childrens Hlth, SE-11883 Stockholm, Sweden.;Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Haines, Helen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Karolinska Inst, Dept Womens & Childrens Hlth, SE-11883 Stockholm, Sweden.;Univ Melbourne, Rural Hlth Acad Ctr, Melbourne Med Sch, Northeast Hlth Wangaratta Educ & Res Unit, Melbourne, Vic, Australia..
    Swedish fathers contemplate the difficulties they face in parenthood2016In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 8, p. 55-62Article in journal (Refereed)
    Abstract [en]

    Objective: The aim was to explore what concerns Swedish fathers had about parenting difficulties at two months after the birth of their baby. Methods: Self-report questionnaires were used and data were analyzed with mixed methods. Results: Thirty percent of the 827 fathers reported concerns about the difficulties of parenthood. The theme 'Managing the demands of being a father' emerged and was based on concerns about how to raise the baby, having enough money, health issues, lack of time and finding balance in the new family pattern. Financial worries, feeling less positive about expecting a baby, and self-reported poor emotional health were related to fathers who perceived parenthood as difficult. Conclusion: Experienced fathers as well as new fathers expressed similar concerns about parenthood. Preparation classes for reassurance and skills coaching about child raising may provide important support for fathers. This is especially important for fathers who may have poor emotional health or who may not be feeling positive about expecting a baby. Policy-makers and health care providers should recognize that offering support for all fathers benefits not only men, but also their children, and their partners and can help encourage egalitarian practices at home and work.

  • 21.
    Johansson, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Wirén, Andrea A
    Karolinska Institutet.
    Ssempasa, Damali
    Karolinska Institutet.
    Wells, Michael
    Karolinska Institutet.
    A qualitative study of midwives’ challenges to support transmen during childbirth: A short report2020In: The European Journal of Midwifery, ISSN 2585-2906Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION Individuals who are transgender often want a family and want to bevalidated as fathers, but may lack support in the reproductive health field. The aim ofthis qualitative study was to explore midwives’ perceptions regarding caring for transmenduring labour and birth.

    METHODS Five midwives were recruited from Stockholm-area hospitals, with interviewslasting 17 minutes on average. Qualitative content analysis using an inductive approachwas used.

    RESULTS Our findings describe the challenges midwives face when caring for transmen inchildbirth, including a lack of knowledge, confusion on working with transgender, how toprovide individualized support, and the complexity of childbirth.

    CONCLUSIONS The midwives faced challenges when caring for transmen in childbirth.Since midwives lacked knowledge regarding best practices to support transmen, theywanted to receive more education on how to care for transmen during birth.

  • 22. Karlström, Annika
    et al.
    Nystedt, Astrid
    Johansson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Hildingsson, Ingegerd
    Behind the myth--few women prefer caesarean section in the absence of medical or obstetrical factors.2011In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, no 5, p. 620-7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to describe the prevalence of women's preference for caesarean section as expressed in mid pregnancy, late pregnancy and one year post partum. An additional aim was to identify associated factors and investigate reasons for the preference.

    DESIGN: mixed methods. Data were collected from 2007 to 2008 through questionnaires distributed to a Swedish regional cohort of women. The survey was part of a longitudinal study of women's attitudes and beliefs related to childbirth. One open question regarding the reasons for the preferred mode of birth was analysed using content analysis.

    SETTING: three hospitals in the county of Västernorrland in the middle of Sweden.

    PARTICIPANTS: 1506 women were recruited at the routine ultrasound screening during weeks 17 to 19 of their pregnancy.

    FINDINGS: a preference for caesarean section was stated by 7.6% of women during mid pregnancy and by 7.0% in late pregnancy. One year post partum 9.8% of the women stated that they would prefer a caesarean section if they were to have another baby. This was related to their birth experience. There were more multiparous women who wished for a caesarean section. Associated factors irrespective of parity were fear of giving birth and a 'strongly disagree' response to the statement regarding that the preferred birth should be as natural as possible. Among multiparous women the strongest predictors were previous caesarean sections, particularly those that were elective, and a previous negative birth experience. Women's comments on their preferred mode of birth revealed five categories: women described caesarean section as their only option relating to obstetrical and/or medical factors; several women stated ambivalent feelings and almost as many described their previous birthing experiences as a reason to prefer a caesarean birth; childbirth-related fear and caesarean section as a safe option were the remaining categories.

    KEY CONCLUSIONS: rising caesarean section rates seem to be related to factors other than women's preferences. Ambivalence towards a way of giving birth is common during pregnancy. This should be of concern for midwives and obstetricians during antenatal care. Information and counselling should be frequent and comprehensive when a discussion on caesarean section is initiated by the pregnant woman. A negative birth experience is related to a future preference for caesarean section and this should be considered by caregivers providing intrapartum care.

  • 23.
    Thies-Lagergren, Li
    et al.
    Department of Midwifery Research - Reproductive, Perinatal and Sexual Health, Lund University, Sweden; Department of Obstetrics and Gynaecology, Helsingborg Lasarett, Sweden.
    Johansson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Department of Obstetrics and Gynaecology, Södersjukhuset, Sweden.
    Intrapartum midwifery care impact Swedish couple's birth experiences: A cross-sectional study2019In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 32, no 3, p. 213-220Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Parents' birth experiences affect bonding with their infant, which in turn may influence the child's future health. Parents' satisfaction with childbirth is multi-dimensional and dependent on both expectations and experiences. Increasing involvement of partners in intrapartum care may lead to an assumption that the birthing couple shares attitudes and expectations of intrapartum care. There is a limited knowledge regarding the uniformity of couples' experiences of labour and birth.

    AIM: To describe and compare uniformity in couples' birth experiences of the quality of intrapartum midwifery care.

    METHOD: A quantitative cross-sectional study nested within a randomised controlled trial. In total 209 healthy primiparous mothers and their partners were recruited. A quality of care index was generated from an on-line questionnaire administered as a follow-up to the randomised controlled trial. Uniformity and differences were identified regarding the coupleś experiences of birth and their preferences for intrapartum care RESULTS: A high level of uniformity between the mothers and their partners was revealed. Birth was a positive experience for 79% of partners and 73% of mothers whom were more likely to have experienced a spontaneous vaginal birth. Partners and mothers with a less positive birth experienced deficiencies regarding: being in control, receiving information about labour progress and midwife's presence in labour room.

    DISCUSSION: Midwives can enhance couples' feeling of being in control during labour and birth by being attentive, present and continuously providing adequate information and emotional support.

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